【作者】 阮氏惠；

【导师】 吴焕林；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 背景冠心病是冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)的简称,亦称为缺血性心脏病,既包括冠状动脉粥样硬化使管腔狭窄或闭塞导致心肌缺血缺氧而引起的心脏病,也包括冠状动脉功能性改变(痉挛),临床表现为心绞痛、心肌梗死、心律失常、心力衰竭等多种形式。根据临床表现,冠心病属于中医“胸痹”、“心痛”、“真心痛”等病范畴。近年来,成用西医辨病、中医辨证、病证结合的模式,对冠心病中医证候进行了大量的研究,取得了一定的进展,但对平板运动试验与中医证候间的相关性研究较少。目的本研究通过对临床诊断为冠心病心绞痛且平板运动试验阳性患者中医证候的判别,探索冠心病平板运动阳性患者的中医证候特征表现及其规律,并分析各种中医证型与冠心病患者运动耐量降低的相关性,从而为进一步提高临床辩证治疗冠心病运动耐量异常患者的疗效,并推动冠心病证候客观化研究及中医药防治冠心病心绞痛运动耐量异常的研究。方法纳入广东省中医院心脏中心2008年4月2009年4月临床诊断症状诊断为冠心病心绞痛且平板运动试验结果阳性的病人54例。由经过培训的人员,在对患者行运动平板试验后两小时后,48小时内,收集患者中医四诊信息和其他病情资料,填写病例观察表,进行数据整理及统计分析。结果1.54例患者中医证候分布规律为:寒凝证占42.6%,气滞证占44.4%,痰浊证63%,瘀血证占87.0%,心气不足证占75.9%,心阴不足证占29.6%,心阳不振证占59.3%。2.54例患者中医症尖较为集中的有胸闷,胸痛,乏力,舌质紫暗,舌质淡白,舌苔厚,舌苔腻,脉滑。结论54例临床诊断为冠心病心绞痛并平板运动实验阳性的患者冠心病中医证候中,以血瘀证47例(87.0%),心气不足证41例(75.9%),痰浊证34例(63.0%)最为常见。由多到少排列为:血瘀证>心气不足证)痰浊证>心阳不振证>气滞证>寒凝证>心阴不足证。结果与既往对胸痹心痛的症候调查的结果相似,不同的是,平板运动阳性患者血瘀,气虚的比例较以往的结果更大,提示运动耐量的异常跟气虚血瘀有更为重要的关系。更多还原

【Abstract】 BackgroundCoronary heart disease is a frequently-occurring diseases,the morbidity and mortality among the first.The current Western focus on prevention and treatment medication,interventional therapy,surgical treatment,and achieved significant therapeutic effect,making more and more patients to bertefit.However,side effects of long-term medication,and revascularization at the same time reducing the mortality rate,but the incidence of complications remains high,the status of traditional Chinese and western medicine for the treatment of coronary heart disease study offers a wjde range of prospects.Chinese medicine treatment of diseases of great importance to the dialectic,however,the lack of dialectical norms of governance,therefore, regulate the use of modern science and technology,modernization of traditional Chinese medicine Chinese medicine symptoms become the focus of the study.The broad masses of medical workers to use physical examination, laboratory examination of the signs of traditional Chinese medicine have been extensively studied,and acbieved remarkable results.Treadmill with the reliability of the diagnosis of coronary heart disease,as symptoms are the feasibility study of Chinese medicine,research in this area is currently less subject to the evaluation of coronary heart disease through the treadmill of Chinese medicine-based distribution of symptoms,signs for the Chinese medicine research to lay the foundation.ObjectiveIn this study,the clinical diagnosis of angina pectoris and positive treadmill exercise in patients with the identification of TCM Syndrome,and explore positive treadmill exercise in patients with coronary heart disease in Chinese medicine and the law of symptom characterized by and analysis of TCM syndrome in patients with coronary heart disease reduced exercise tolerance of the correlation,so as to further enhance the Clinical Diagnosis and Treatment of coronary heart disease in patients with abnormal exercise tolerance efficacy,and to promote further objective evidence of coronary heart disease and angina p(?)(?)toris in Chinese medicine to combat abnormal exercise tolerance studies.MethodsInto the Guangdong Provincial TCM Hospital Heart Center in April 2008-2009 clinical diagnosis in April was diagnosed with symptoms of angina pectoris and positive treadmill exercise test results of 54 cases of patients,By trained personnel,patients in the treadmill for two hours after the experiment, the 48 hours to collect four diagnostic information in patients with Chinese medicine and other disease information,fill out the form observed cases,data collation and statistical analysis.Results54 cases of Chinese medicine syndromes in patients with distribution as follows:blood cards accounted for 87.0%,heart card gas account for less than 75.9%,63.0%phlegm card,heart card yang weak 59.3%,42.6%card,gas accounted for 44.4%of stagnation heart.yam 29.6%less than evidence.ConclusionClinical diagnosis of 54 cases of angina pectoris and positive treadmill exercise test in patients with coronary heart disease syndromes in traditional Chinese medicine,blood stasis in 47 cases(87.0%),heart certified 41 cases of gas shortage(79.5%),34 cases of phlegm card(63.0%) most common.By decreasing order as follows:Blood Stasis>Heart insufficient gas card> phlegm cardgt;Yang weak heart cardgt;Qi stagnation;card;Heart Yin insufficient evidence.The results of previous symptoms of chest pain similar to the findings of the survey,difference is that the treadmill exercise in patients with positive blood stasis,qi deficiency of the results of the ratio greater than before,suggesting that abnormal exercise tolerance with the Qi-deficiency and blood stasis are the more important the relationship between the.更多还原